Thursday, June 16, 2011

A Day in the Life or "I am my daughter's pancreas"

6:00 am

The tinny and inexpensive digital alarm clock perched on top of the bed rail above our heads begins it’s morning routine by clicking on. The announcer from National Public Radio then jolts us awake by filling us in on some major national or international news event. As Carol and bemoan the fact that we once again didn’t get enough sleep, we both realize that we’d better get moving or the daunting morning routine will not be accomplished in time for Leslie to catch the bus to school.
By 6:10 we usually roll out of bed and head to the bathroom. Carol quickly dresses and heads downstairs. I stumble into the bathroom for my morning shave and shower ritual.

Now fully dressed and fully awake, I pass Leslie’s room on my way down the stairs. Her light is usually on by this time and I give her my morning through-the-door greeting, “Good morning Leslie. Did you sleep well?” followed by my must-ask diabetes question, “What was your number this morning?”

Leslie groans and says, “Hi Dad. 185.” Meaning, for those who don’t live with diabetes, that her blood glucose level is 185 milligrams per deciliter (mg/dL). Her target blood sugar is 110 - 120 so her number this morning is a bit high. Unfortunately, she is often high in the mornings. This is her first blood sugar test of the day – the small and sharp needle is jabbed into her fingertip producing a small droplet of blood that is then touched to the disposable test strip in her meter, which then tells her the current glucose level in her blood. (The retail cost of her test strips is $0.58 per strip.)

I ask, “Did you correct?” knowing, with near 100% certainty but afraid to assume so, that she has already given enough insulin with her pump to bring her blood sugar down to the target level.

Her predictable answer is then provided, “Yes.” Even though I know she knows to check and then correct her blood sugar levels, I don’t dare assume so. If I don’t ask and this is one of those mornings that she happens to have an extremely high blood sugar, uncorrected, then the additional rise in her blood sugar from eating breakfast could make her sick. It has happened before – not often, but often enough for me to routinely ask the question.

After hearing her reassuring, “yes,” I bound down our comfortably carpeted stairs, walk down the hallway and turn the corner into the kitchen and nook. The first thing I notice when I walk into our nook is the beautiful view from the bay window. Our house overlooks the woods and the onslaught of the color green is a welcome sight each and every time I pass that particular window.

By this time, now approaching 7:00, Carol has been preparing breakfast for approximately half an hour. Breakfast in a household in which a person with diabetes lives merits some explanation and it is here that I must credit Carol. In the early days after Leslie’s diagnosis, she spent hours researching diabetes-friendly diets and guided the entire family in a transition to much more healthy eating habits. We have all benefited from what she learned, though the changes were not always easy to live with.

First of all, the most common breakfast foods are probably among the worst foods anyone can eat, let alone someone with diabetes. Before I describe what the Johnson family eats for breakfast, I’ll discuss a typical American breakfast and explain why it should be avoided.

Example 1: Orange juice, a bagel with cream cheese, and some fruit.
Orange juice is made by squeezing the juice from oranges, leaving most of the pulp behind. The delicious end product is essentially a sugar drink. Fructose, the sugar found in most fruits, raises blood sugar rapidly and effectively. It is so rapid and effective, that most people with diabetes will use orange juice to bring up their low blood sugars in lieu of eating a glucose (pure sugar) tablet. Why, then, would someone with diabetes want to drink 8 ounces of nearly-pure sugar first thing in the morning, raising their blood sugar must faster than insulin can counteract it? (Note - Today’s fast acting insulin takes about 2 hours to work; orange juice can raise a person’s blood sugar in just a few minutes.) Why would a person with diabetes drink OJ and cause their blood sugar to spike? It tastes good. That’s probably okay for the occasional glass of juice, but it is not okay as a daily ritual because it will perpetuate consistently high blood sugars. (8 ounces of orange juice contains 30 grams of carbohydrate – enough to raise Leslie’s blood sugar 200 mg/dL.)

What about the bagel? Most people assume that a bagel is a better breakfast choice than a donut. And, if you were thinking about the fat intake, your assumption would be correct. But if you were concerned about blood sugar spikes and carbohydrate intake, you would be dead wrong. A Krispe Kreme glazed donut has 22 carbohydrate grams. A Panera Bread Whole Grain Bagel contains 66 grams. I’m not advocating a diet filled with yummy donuts; rather I am advocating that people be aware of what is in the food they eat. Who would have thought?

The cream cheese has only 2 carbohydrate grams, so its effect on blood sugar will be minimal.

Depending upon the choice of fruit, the effects on blood sugar can vary between minimal and significant. A high-fiber apple contains 23 carbohydrate grams but it will only slowly raise blood sugar due to all the fiber it also contains. Fiber slows down the rate at which the body digests the food, thereby slowing down the release of sugar into the blood stream. A cup of grapes has very little fiber and 15 carb grams. Though the carbohydrate count is lower, the grapes will likely cause a faster blood sugar spike due to their low fiber content.
The bottom line: A glass of orange juice with a bagel and some grapes will pump about 110 grams of carbohydrate into you system. If you don’t have diabetes, then your blood sugar will probably only spike marginally before your pancreas produces enough insulin to allow the sugar to be absorbed and used where it is needed. If you have diabetes, your artificial insulin will do the same, but it will likely take it more time. The result will be a significant rise in blood sugar and, as we have discussed, such highs take their toll on your body and your overall health. 110 carbohydrate grams is approximately 1/3 of an average adult’s daily-recommended intake – breakfast is usually a person’s lightest meal of the day.

We usually don’t have juice and bagels for breakfast.

What do we eat? A typical breakfast is oatmeal (steel cut oats – whole grain – to slow the rate at which the carbohydrates are converted by the body into sugar and thereby prevent a large blood sugar spike after the meal); in the oatmeal are some cut-up bits of sausage (no carbohydrates but plenty of protein) and some raisins (for flavor). Served with the oatmeal is almost always some sort fruit (a peach, strawberries, or cantaloupe). The carbohydrate count might be comparable to a cereal breakfast, but it will contain more fiber and some protein to slow the carbohydrate-to-sugar conversion.

Next Post? 7:00 am

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